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Limiting the Scope Of Review on Redeterminations and Reconsiderations of Certain Claims

CMS recently provided direction to MACs and QICs regarding the applicable scope of review for redeterminations and reconsiderations for certain claims.
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AHCA to Launch Major Grassroots Campaign Regarding CMS Proposed Rule on Requirements of Participation

Review or key areas of interest in the Proposed Rule on requirement of Participation, and AHCA Grassroots campaign.
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3 Stars or Better Critical for CCJR Model

On July 9, 2015, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule on the Comprehensive Care for Joint Replacement (CCJR) demonstration model.
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MMR Status Quo

Since the enactment of MACRA (Medicare Access and CHIP Reauthorization Act of 2015), AHCA and other therapy professional and provider organizations have been in regular contact with CMS to clarify the intent of the legislation, ask questions, and provide recommendations regarding implementation. The information provided by AHCA is an update as to the status of the CMS implementation of the new targeting requirements based upon these communications with CMS.
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CMS Unveils New Proposal on Bundled Payments for Hip and Knee Surgeries

CMS unveiled a 500+ page document detailing plans to implement a new Medicare Part A and B bundled payment model for hip and knee replacement surgeries.
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CMS Releases CY2016 Physician Fee Schedule Proposed Rule

First Physician Fee Schedule Since SGR Repeal Courtesy of NASL.org
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Remember the 68 percent solution

June 11th, CMS quietly announced that as part of its 68-percent solution, it had paid out about $1.3 billion to 1,900 hospitals that had agreed to the settlement.
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AHA and AHCA on Same Page

Both the AHA and AHCA agreed that the use of the proposed therapy measure would lead to inadequate and worthless data, claiming therapist compliance to the completion of a piece paper yields little about actual outcomes.
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U.S. Supreme Court Rules in Favor of Administration - What This Means for AHCA-NCAL Members

The U.S. Supreme Court (SCOTUS) released its decision in King v. Burwell, finding in favor of the Obama Administration. This decision upholds the Internal Revenue Service (IRS) Affordable Care Act (ACA)-related rule that extends tax-credit subsidies to individuals who purchase insurance through either a state- or federally-run exchange.
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MMR Cycles Continue

Providers continue to feel the pain of the 5 cycle MMR review process under RACs for 2014 claims. The 2015 “Doc Fix” with legislated changes to the medical review process has yet to be implemented by CMS.
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